On Election Eve, Outcome of Senate Could Determine Policy Direction

After Republicans swept the mid-term elections, the party was catapulted back into power in the House of Representatives. At that time, conventional wisdom was that Republicans would take control of the Senate in 2012, due to the GOP’s momentum and the number of Democratic senators retiring from red states. Of course, what a difference a year and a half, or even a few months, can make during an election season.

Now, even though many races are too close to call, with several Senate races potentially heading towards recounts, the Democrats may retain control of the Senate. With the House expected to stay Republican, if the Democrats keep their slim majority in the Senate, the re-election of President Obama would maintain status quo, while the election of Governor Mitt Romney would force him to work with Senate Democrats to move legislation.

There are several key senate races across the country. In Massachusetts, Sen. Scott Brown, R-MA, whose election tipped the scales during the health-care reform debate and forced Democrats to pass health reform with a simple majority, is in a close battle defending his seat against consumer advocate Elizabeth Warren. Ms. Warren may squeeze out a victory since Obama is very popular in the blue state. In Missouri, Sen. Claire McCaskill, D-MO, who was seen as a very vulnerable incumbent, drew new life and momentum after Rep. Todd Akin’s rape comment elicited scorn from the Republican establishment. Similarly in Indiana, Democrat Joe Donnelly has gained momentum after Republican Richard Mourdock’s controversial rape remark and has given Democrats hope in a race that initially looked like a long shot. However, Senate races in Nevada, North Dakota, Montana and Wisconsin are all neck and neck and could face recounts because they are so close.

What does all this mean for gastroenterologists and why should you care?

A Democratic Senate means that a Romney administration would not have an easy time moving legislation and would need to secure a handful of Democratic votes to move his priorities through the Senate. Of course, Romney has stated that he will repeal “Obamacare” on day one of his administration, although if Democrats hold the Senate, that may be a tall order. There will be increasing pressure to find common ground with Democrats on altering, changing or improving health-care reform rather than repealing it. Even some House Republican offices with which I have recently met have conceded that they don’t think the Senate will flip and, therefore, need to work on altering the law and making some changes to it.

Many of the physician reporting mandates — Physicians Quality Reporting System, meaningful use, electronic health records and the value-based payment modifier — were either established before the Patient Protection and Affordable Care Act or have the support of Republicans and are likely not going away. Regardless of who wins the Senate or the White House, the physician community will need to be engaged in the legislative and regulatory process to advocate for appropriate changes to these programs that make them more meaningful and beneficial to physicians and their patients.

The first order of business for the Obama or Romney administration will be to address the sequester cuts as well as the Medicare physician payment cuts. Physicians could see cuts of nearly 29 percent if the scheduled Medicare cuts (26.5 percent) and the sequestration cuts (2 percent) are implemented. Most legislators recognize that this cannot happen and conventional wisdom states that a two or three month patch will be put in place during the lame duck session to delay the cuts to give Congress time to come up with a comprehensive plan next year.

At least after Tuesday, the election will be over. Then we prepare for recounts and the lame duck session, and the real work begins.

Join Carla Ginsburg, MD, MPH, AGAF, chair, AGA Public Affairs & Advocacy Committee, on Thursday, Nov. 15 at 8 p.m. ET for a webinar, Post-election Lame Duck: What This Will Mean for GI, on issues important to practice. Learn more about the projected practice reimbursement cuts, the effect of sequestration on the practice of medicine and quality reporting milestones. Register Now

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